Jammet P, Weber S, Degeorges M
Ann Med Interne (Paris). 1983;134(2):139-43.
Dobutamine, a selective agonist of beta I adrenergic receptors was proposed as an inotropic support of the failing left ventricle in the acute phase of myocardial infarction. We studied the action of Dobutamine (10 micrograms/kg/min) on subendocardial perfusion, compared to the effects of an equipotent dose of Dopamine, in 10 patients with acute transmural infarction. Subendocardial perfusion was assessed by subendocardial viability ratio (EVR), ratio of the diastolic pressure-time index to the systolic pressure-time index. A mean 35 p. cent increase in cardiac index was observed with 10 micrograms/kg/min Dopamine, and with 6,75 micrograms/kg/min Dobutamine; heart rate increased by 13 p. cent with both drugs; with Dobutamine, systolic arterial pressure increased by 9,6 p. cent while pulmonary wedge pressure decreased by 34 p. cent; Dopamine increased systolic arterial pressure by 19 p. cent while pulmonary wedge pressure remained unchanged. Subendocardial viability ratio decreased by 25 p. cent with Dopamine (p less than 0,01) but only by 14 p. cent with Dobutamine (p less than 0,01). Thus, there was significantly less impairment of subendocardial perfusion with Dobutamine and its use is preferable when inotropic support of the failing left ventricle is necessary in the acute stage of myocardial infarction.
多巴酚丁胺是β1肾上腺素能受体的选择性激动剂，被提议用于心肌梗死急性期对衰竭左心室的正性肌力支持。我们对10例急性透壁性梗死患者进行研究，比较了多巴酚丁胺（10微克/千克/分钟）与等剂量多巴胺对心内膜下灌注的作用。心内膜下灌注通过心内膜下存活比率（EVR）进行评估，即舒张压时间指数与收缩压时间指数之比。使用10微克/千克/分钟多巴胺和6.75微克/千克/分钟多巴酚丁胺时，心脏指数平均分别增加35%；两种药物均可使心率增加13%；使用多巴酚丁胺时，收缩动脉压升高9.6%，肺楔压降低34%；使用多巴胺时，收缩动脉压升高19%，肺楔压保持不变。使用多巴胺时心内膜下存活比率降低25%（p<0.01），而使用多巴酚丁胺时仅降低14%（p<0.01）。因此，多巴酚丁胺对心内膜下灌注的损害明显较小，在心肌梗死急性期需要对衰竭左心室进行正性肌力支持时，多巴酚丁胺的使用更为可取。
